Oregon says it now has about 600 contact tracers. But will that be enough?

Published 8:00 am Wednesday, June 24, 2020

SALEM — State and local public health authorities have not yet built a fully robust system for contact tracing four months after coronavirus began sweeping through Oregon, according to public records released Tuesday, June 23.

The Oregon Health Authority in May said health officials would need at least 631 full-time contact tracers, who are key in reducing the virus’ spread by identifying who may have been exposed to known infections. Officials later said the number would likely rise to “800 or more positions.”

The actual tally as of June 12? “About 600 people,” the health authority revealed.

Records released by the Oregon Health Authority also appear to show 11 counties still lacked the tracers that state officials initially declared each “must have” before gradually easing stay-home order restrictions. That includes Multnomah, Washington, Clackamas and Marion counties, home to the state’s greatest number of infections.

Dr. Thomas Jeanne, the state’s deputy health officer and deputy epidemiologist, said state and county public health authorities have made strong progress. The number of workers available to perform contact tracing has quadrupled, he said, since they identified the first infection Feb. 28.

“I think this is a good step forward for us as a state,” he said. “It’s really encouraging to see. But we’re not done yet.”

Disclosure of the worker counts comes three weeks after The Oregonian/OregonLive filed a public records request for the data. State officials previously said they did not know how many tracers were working but would survey counties to find out.

Oregon’s contact tracing capacity has already come under strain despite having relatively few cases compared to other states, with 7,274 confirmed or presumed infections. A recent outbreak at a Lincoln County seafood facility on the Oregon Coast, for example, sent officials scrambling to increase staffing to slow the spread of the virus.

The state’s benchmark of 631 contact tracers is based on 15 workers per 100,000 residents. Some public health experts have said the number should be double that during the pandemic.

Gov. Kate Brown allowed several Oregon counties to move forward with reopening despite not hitting the lower benchmark, provided that each county submit a staffing plan. Officials argued that it didn’t make sense to require workers in areas with few cases.

While there’s no correct number of tracers, and many variables are at play, one estimate suggests Oregon might need 1,209 workers based on recent trends that include record-level infections over the past two weeks.

That projection assumes every infection is investigated and each infection has 10 contacts. Cutting both metrics in half still shows Oregon could need upward of 700 tracers.

“That suggests that there might be some work to do,” said Candice Chen, an associate professor at The George Washington University who is involved in the estimates.

The George Washington University and two national organizations, representing public health agencies and officials, built the online estimator. An analysis by National Public Radio using that estimator last week suggested Oregon was one of seven states with enough tracers.

But the estimator updates daily, based on infection counts.

Chen said it’s possible Oregon could get by with 600-something tracers if state and local public health agencies are able to work together seamlessly.

“There’s a lot of unknowns,” she said.

Public health officials use contact tracing to slow the spread of contagious diseases. Workers called case investigators interview someone who is infected, asking detailed questions about when they became sick and people they may have exposed. Workers called contact tracers use that information to notify people who were in close contact to the infected person and advise them to quarantine at home.

The tally released by Oregon on June 23 distinguishes between tracers and investigators, to include all workers, keeping in line with national projections.

Jeanne, Oregon’s deputy epidemiologist, said it’s “not implausible” 1,200 or more could eventually be needed statewide.

But Jeanne also said “there’s not a timeline or number” for more staff, acknowledging he was not aware of the 800-worker figure previously disclosed by the state in a draft plan. Officials never finalized that document.

“We met the initial target and we’re going to expand as needed,” he said, insisting that Oregon had accomplished its original goal.

The Oregon Health Authority did not claim in its press release that it surpassed 631 full-time workers, however, announcing in a carefully worded statement that “the current statewide total of county and state contact tracers is now about 600 people.”

That includes nearly 100 state employees who are “ready to assist counties with case investigation and contact tracing in the event of an outbreak.”

The tally also came with several caveats.

It listed as many as 63 workers in Multnomah County, for instance, even though 19 of those are only part time and equal only 6 full-time employees. It also included 45 volunteers or university students in Lane County and several workers who had not yet been hired in several jurisdictions.

Meanwhile, four counties did not provide updated worker counts beyond what was initially shared in April.

The sum of all workers listed, by county, totals about 565. The Oregon Health Authority could not say how many of its additional 100 listed workers had actually performed contact tracing, although some have been assigned to outbreaks in Lincoln and Union counties.

Meanwhile, officials in the Portland area acknowledged they are still working to hire and train tracers.

Kate Willson, a Multnomah County spokeswoman, said officials plan to meet the state’s goal for the county of 122 full-time-equivalent workers by the end of July.

Washington County was listed by the state as having only 68 workers, below the 90 needed. A spokeswoman, Mary Sawyers, said staffing totals should hit 86 by early July.

Clackamas County had only 29 full-time-equivalent workers, according to the state, far short of the 63 needed. A county spokesman declined to say when the county would hit its benchmark but wrote in a statement that “we are continuing to hire as time goes on.”

Marion County officials, which reportedly have only 30 of the needed 52 workers, didn’t respond to a request for comment.

It appears more contact tracers have helped Oregon investigate infections.

State officials set a benchmark that investigators should attempt to contact someone with an infection within 24 hours, 95% of the time.

Workers regularly failed to hit that until May, according to state statistics. But now the benchmark is regularly surpassed.

Whether it is a truly useful indicator remains to be seen, however.

Jeanne, the state’s deputy health officer, was unaware of the precise definition the state was using. He assumed officials needed to actually speak to the person — not simply attempt to reach someone.

“I don’t see how that’s very useful,” he said of tracking whether someone had only left a voicemail.

An agency spokesman later confirmed the metric tracks only an “attempted contact.”

This article was originally published by The Oregonian/OregonLive, one of more than a dozen news organizations throughout the state sharing their coverage of the novel coronavirus outbreak to help inform Oregonians about this evolving heath issue.

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